xRead - Nasal Obstruction (September 2024) Full Articles

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reflect improved OS compared to patients with similarly staged disease not treated with neoadjuvant therapy. The prospective clinical trials will be informative of its role and outcomes. Intra-arterial neoadjuvant chemotherapy may be useful for treatment of advanced maxillary sinus carcinomas as it demonstrates the ability to minimize tox icity from chemotherapeutic drugs. However, it is unclear which patients would benefit most from this therapy. Fur ther studies are required to fully understand its indications and applications. Review of articles regarding IC is found in Table XXI.A.1. Role of induction/neoadjuvant chemotherapy in sinonasal SCC

ment of diverse sinonasal pathologies, including aggres sive malignancies such as SNSCC, via an endoscopic approach has become more widely accepted. Regardless of surgical approach, the literature is uniformly in agreement regarding the importance of negative surgical margins. Unlike SCC at other subsites within the head and neck, however, there are no clear recommendations regard ing margin size for SNSCC. This is due to both lack of data and the impracticality of achieving wide margins (i.e., 1 cm) for the vast majority of SNSCC tumors. In an NCDB review of 7808 patients with SNSCC, when compared to patients with SNSCC treated nonsurgically, propensity score-matched results demonstrated improved OS in surgical patients with negative surgical margins and micro-positive surgical margins ( p < 0.001), but patients with macro-positive surgical margins did not demonstrate improvement ( p = 0.20). 161 In a 2018 NCDB review of 1483 patients with SNSCC without regional or distant metastasis treated between 2010 and 2014, Kilic et al. compared outcomes of the endo scopic approach to outcomes of the open approach. Of the 1483 patients identified, 353 (25.8%) were treated with an endoscopic approach and 1130 (76.2%) were treated with an open approach. Propensity score matching was uti lized, and there was no significant difference in 5-year OS between the two groups. 135 This is further corroborated by several retrospective case series, which have reported comparable long-term out comes and survival rates between endoscopic and open approaches for both SNM in general and specifically for SNSCC. 316,1084–1086 In a retrospective review of 43 patients with SNSCC, Nicolai et al. report an overall recurrence rate of 16.2% (7/43), with a 12% (3/25) recurrence rate reported in patients treated via endoscopic approach and a 22.2% (4/18) recurrence rated reported in patients treated via an open approach. 316 Similarly, in a retrospective review of 21 patients with SNSCC who underwent endo scopic resection, Luong et al. report an overall recurrence rate of 24% (5/21). However, 57% (12/21) of this patient cohort had T4 disease. 1086 More recently, a retrospective review of 15 patients with SNSCC who underwent endo scopic resection, none of whom had T4 disease, identified a 5-year OS of 72.4%, DSS of 79.6%, and LRC rate of 92.9%. 140 These results are supported by two large position papers—the EPOS on Endoscopic Management of Tumours of the Nose, Paranasal Sinuses, and Skull Base from 2010 6 and the more recently published ICSB 2019. 5 Within the EPOS, a systematic review concluded that the DFS between patients treated via either endoscopic or open approach was comparable but depended on the completeness of resection. 6 Similarly, the ICSB concluded that endoscopic and open resection of SNSCC had similar

Aggregate grade of evidence

C (Level 3: one study; Level 4: four studies)

Benefit

Patients who respond to induction chemotherapy demonstrate improved OS andDFS. There are systemic toxicities related to neoadjuvant therapy. Selective intraarterial neoadjuvant chemotherapy seems to reduce the rate and severity of toxicity. outcomes. Progression of disease during the neoadjuvant treatment period may lead to less favorable outcomes. Insufficient data to make recommendation regarding long-term costs of neoadjuvant therapy. The stage of tumor at presentation and the goals of the patient with respect to orbit preservation should be carefully considered. It is important to consider that negative margin resection remains the primary goal with most cases of SNSCC. Additionally, inappropriate patient selection may lead to less favorable Balance of benefits and harms.

Harm

Cost

Benefits–harm assessment

Value

judgments

Policy level Option. Intervention Patients with locally advanced disease (i.e.,

orbit or intracranial invasion) may have benefit from neoadjuvant chemotherapy. Response to neoadjuvant chemotherapy offers prognostic information.

b Role of surgery While there is emerging evidence for nonsurgical treat ment protocols, surgical resection of SNSCC remains the mainstay of treatment. Traditionally, SNM, includ ing SNSCC, amenable to surgical resection necessitated an open approach. However, with the advancement of endonasal techniques over the past three decades, treat